Vaginismus

imagesDefinition: This is the spasmodic contraction of the pelvic floor muscles often associated with that of gluteal muscles and adductors of the thighs and the patient becomes opisthotonos whenever coitus or even vaginal examination is attempted. The patient runs hysterical on vaginismus.

Causes:

  1. Psychogenic Causes:
  2. Poor sex education
  3. Wrong upbringing
  4. Childhood vulvo-vaginal infection or trauma
  5. Husband-wife psychogenic incompatibility

All the above factors make the girl develop psychogenic complex. This factor is always combined with local genital factor.

  1. Genital Causes:
  2. Narrow vaginal introitus in newly married young girl
  3. Tight hymeneal ring
  4. Tender fissure in the hymen caused by forceful intercourse
  5. Vaginal atresia or stenosis
  6. Vaginitis
  7. Cystitis
  8. Difficulty in abduction of thighs due to orthopaedic cause

Treatment:

  1. Prophylaxis:

Proper upbringing and sex education are important. Premarital examintation can detect this problem early.

  1. Curative Treatment:

In mild cases, the treatment is required in early stage. The husband is instructed to gradually adopt coital act instead of forcing. The wife is assured, transquilisers and antispasmodics are administered before coitus, erotic love play is extended, vaginal introitus is lubricated with water soluble KY jelly and local anaesthetic ointment. These can overcome the spasm with gradual successful coitus and vaginal dilatation. Pregnancy and childbirth by vagina cure the condition. In severe cases, the attempt on coitus is temporarily suspended. The wife is treated with sedative and tranquilizers. Her vaginal introitus is treated manually under general anesthesia. She is convinced that her passage has been corrected. Thereafter a vaginal dilator, graduated increasing sizes, is fitted for 15 minutes daily till the maximum size is administered. She is instructed to fit in the dilator at home for 2-3 weeks.

When she is convinced that her passage is normal, coitus is allowed. In cases with narrow introitus and tight hymeneal ring- Fenton’s operation is performed. Some severe cases of vaginismus are not fully cured even after childbirth per vagina. Fenton Operation: In this operation, a transverse incision is made on the muco-cutaneous junction of the fourchette under general anesthesia. A flap of posterior vaginal mucosa is dissected off from the perineal muscle extending above the hymeneal ring. The ring is incised at two lateral sides of the vaginal flap. The perineal muscles are divided vertically in the midline. The vaginal flap margins are transversely sutured to the perineal skin margins. Coitus is attempted in relief of stitch pain.

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Dhaatugat Jvar
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